Resident Clinical Responsibilities
Resident
Training Program: Family Medicine
In compliance with the University
Hospital Rules and Regulations and the UAMS College of Medicine GME Committee
policy on supervision, the following provisions apply: Residents/fellows are
under supervision of attending faculty physicians who are members of the
active Medical Staff and appropriately credentialled.
There are explicit written descriptions of supervisory lines of
responsibility for the care of patients developed by the training Program
Director and communicated to all residents, and all attending physicians
within the program. Residents
have reliable systems for communication and interaction with supervisory
attending physicians. Residents
are supervised in such a way that the resident assumes progressively
increasing responsibility according to their level of education, ability and
experience. On call schedules for
attending physicians are structured to ensure that supervision is readily
available to residents on duty.
The roles,
responsibilities and functions of a Department of Family and Community
Medicine
resident,
per training year, are as follows:
I.
PG-I
1.
Develop and maintain a personal program of self-study and professional
growth with guidance of the faculty.
2.
See
broad spectrum of undifferentiated patients on all shifts, in order of
presentation of assignment by attending or senior resident with an emphasis on
quality of patient evaluation and care.
3.
Perform
the initial assessment of the patient and actively participate in all aspects
of patient care, including history and physical, diagnostic and therapeutic
planning, procedures, writing orders, and interactions with family.
4.
In-depth
discussion of all cases with the attending prior to initiation of all but the
most basic diagnostic studies or therapeutic interventions.
5.
No
supervision or direction of decisions of other residents or medical students,
but ensure active student involvement in the care of the patients the student
is following.
6.
All
procedures must be done under direct approval and supervision of attending.
7.
Demonstrate
a fundamental awareness and sensitivity to patient and family issues
(including age, gender and cultural diversity).
8.
Use
basic communication skills in encounters with patients and families.
9.
Responsible
for maintaining medical records.
10.
Meets
all documentation requirements of the Residency Program.
II.
PG-II
1.
Develop
and maintain a personal program of self-study and professional growth with
guidance of the faculty.
2.
Responsible
to be familiar with patients and serve as the attendings’ principal resource
for day-by-day patient data.
3.
Responsible
for supervising both interns and students.
4.
Emphasis
on gaining experience with full spectrum of procedures, honing proficiency,
and balancing quality of patient evaluation and care with improved overall
efficiency.
5.
May
initiate common diagnostic studies and therapeutic interventions in straight
forward patients, prior to attending presentation.
6.
Decisions
regarding invasive procedures, change in plans, discharge or problems are
discussed in-depth with the attending. Specialized diagnostic studies,
uncommon therapeutic interventions, and use of consultants, must be discussed
with the attending prior to initiation.
7.
All
procedures must be done with complete attending supervision and approval.
8.
May
take selected presentations from interns or medical students with attending
approval.
9.
Demonstrate
an intermediate awareness and sensitivity to patient and family issues
(including age, gender and cultural diversity).
10.
Use
more advanced communication skills in encounters with patients and families.
11.
Responsible
for maintaining medical records.
12.
Meets
all documentation requirements of the Residency Program.
III.
PG-III
1.
Develop and maintain a personal program of self-study and professional
growth with guidance of the faculty.
2.
Play supervisory role with increased
teaching, consultative and research activities.
3.
Continue to see broad spectrum of
patients, but with emphasis on those with highest acuity or greatest critical
illness.
4.
Emphasis on time, resource and
efficiency management. Goal is to
gain competence in managing administrative, patient flow and team coordination
activities, as well as continuing direct primary care of multiple patients.
5.
Demonstrate proficiency with full range
of medical procedures.
6.
Must discuss all cases with the
attending prior to disposition decisions.
May initiate common diagnostic studies and therapeutic interventions
prior to attending discussion. May
also initiate more sophisticated diagnostic studies and therapeutic
interventions, with attending approval.
7.
May take presentations from lower level
residents and medical students and assist in their patient care management,
with attending approval.
8.
May attempt or initiate procedures,
with attending approval.
9.
May assist with the attempt, or
initiation of, procedures by more junior level housestaff, with attending
approval (and if so certified by the residency training program, as
appropriate.)
10.
Responsible
for informing the on-call resident of all patient care issues.
11.
Demonstrate
a superior awareness and sensitivity to patient and family issues (including
age, gender and cultural diversity).
12.
Use
advanced communication skills in encounters with patients and families.
13.
Responsible
for maintaining medical records.
The attending physician is expected to
see every patient within 24 hours of admission. He/she is to write a note
describing and confirming the patient’s history, examination, problem and
the diagnostic and therapeutic plans. The
attending physician is also encouraged to discuss topics relevant to the
patients on the service with the students, interns, and residents. The attending physician is to see every patient on the
service daily and to write a daily progress note.
The attending must take responsibility to ensure that all of the
clinical decisions made on the patient are appropriate.
Residents are to be taught how to arrive at those decisions, and as
competence is proven the resident should be given the opportunity to make
supervised clinical decisions. He or she must be certain that therapy is appropriate, that
diagnostic studies and particularly invasive procedures are necessary,
cost-effective and efficient, and that high quality care is provided.
It is the
responsibility of the residents and fellows to write patient care orders.
"Do Not Resuscitate", "Comfort Care", or
"Withdrawal of Cardiopulmonary Support" orders must be countersigned
according to hospital policy ML.3.03 Care of Hopeless/Moribund Patients.
The attending also has an obligation to
provide high quality instruction in diagnosis, treatment and pathophysiology
to both the residents and students on the service.
Clinical rounds must be balanced into both work rounds and teaching
rounds at the bedside.
In compliance with the UAMS College of
Medicine GME Committee policy on Evaluation and Promotion, the following
provisions apply: The training program develops physicians clinically
competent in the field. Clinical
competence requires:
1. a solid fund of basic and clinical
science knowledge
2. a solid fund of knowledge of the
healthcare system
3. the ability to perform an adequate
history and physical examination
4. the ability to appropriately order
and interpret diagnostic tests
5. adequate technical skills to perform
selected diagnostic procedures
6. clinical judgement to critically
apply the above data to individual patients and patient populations
7. ethical behavior and professional
attitudes, including appropriate interpersonal interactions with patients,
professional colleagues, supervisory faculty and all paramedical personnel
8. personal integrity which includes
strict avoidance of substance abuse, theft and unexcused absences
9. regular and timely attendance at the
educational activities of the training program
10. satisfactory performance on
rotations as determined by the faculty and/or program director.
For the complete criteria for
advancement of residents, see the Residency Policy and Procedure Manual.
Evaluation
and Advancement
Each of the above elements of clinical competence is assessed on a regular basis by direct faculty supervisors with subsequent review by the Program Director. Evaluation by peer resident physicians, nursing staff and other paramedical staff may be included at less frequent intervals. Each resident meets with the Program Director annually and with his/her advisor at least twice a year to review evaluations, in-service scores, clinical evaluation exercises and other assessments. Advancement to the subsequent year of training with greater involvement and independence in specific patient care activities requires satisfactory ratings on these evaluations per the protocol in the training program. In each year of training, responsibility for patient care must increase. This increased responsibility is drawn from many different facets in the residency training process and includes clinical training and teaching responsibilities to the less experienced members of the team. The resident, in addition to regular physician duties and a responsibility to continue education, manages the patient care team and reports to the attending faculty physician.